'That gave me a lot of comfort, that he would ask my opinion about how we wanted to talk about this': A qualitative analysis of clinical communication experiences of ostomy patients

OBJECTIVES

The purpose of this study was to investigate the communication challenges and successes that people with ostomies experienced during their healthcare encounters.

DESIGN

We conducted semistructured interviews of people with ostomies. Interviews focused on important social situations and health communication strategies for managing these situations. We transcribed interviews and coded them to create themes.

PARTICIPANTS

Participants were eligible to participate if they were above the age of 18 and have had an ostomy for at least a year. 27 people participated in the study.

SETTING

The study was conducted in a university setting.

RESULTS

Interviews with ostomates surfaced several themes related to ostomate needs. Participants benefited from communication that was open, thorough and had a positive outlook on ostomies. Participants found patient-clinician communication to be challenging when there was a lack of knowledge surrounding ostomy care, communication was unclear or inadequate, and when clinicians had a negative outlook on ostomies.

CONCLUSIONS

Findings from this project are intended to amplify existing patient and clinician education materials and to inform the creation of a communication guide specifically for the ostomy context.

CDC field triage criteria accurately predicts outcomes in high impact trauma

BACKGROUND

The precision of emergency medical services (EMS) triage criteria dictates whether an injured patient receives appropriate care. The trauma triage protocol is a decision scheme that groups patients into triage categories of major, moderate and minor. We hypothesized that there is a difference between trauma triage category and injury severity score (ISS).

METHODS

This retrospective, observational study was conducted to investigate a difference between trauma triage category and ISS. Bivariate analysis was used to test for differences between the subgroup means. The differences between the group means on each measure were analyzed for direction and statistical significance using ANOVA for continuous variables and chi square tests for categorical variables. Logistic and linear regressions were performed to evaluate factors predicting mortality, ICU length of stay.

RESULTS

With respect to trauma triage category, our findings indicate that minor and moderate triage categories are similar with respect to ISS, GCS, ICU LOS, hospital LOS, and mortality. However, after excluding for low impact injuries (falls), differences between the minor and moderate categories were evident when comparing to ISS, GCS, ICU LOS, and hospital LOS. Additionally, after excluding for low impact injures, ISS, ICU LOS, and hospital stay were found to correlate well with trauma triage category.

CONCLUSIONS

In this retrospective, observational study significant differences were not seen when comparing ISS with the trauma triage categories of moderate and minor during our initial analysis. However, a difference was found after excluding for low impact injuries. These findings suggest that CDC criteria accurately predicts outcomes in high impact trauma.

Influences of Mental Illness Stigma on Perceptions of and Responses to Requests for Favors

This article examines mental illness stigma effects on a request for a favor from a mentally ill individual. Four hundred and fourteen participants interacted with a hypothetical target on Facebook who was believed to have schizophrenia, depression, or a tooth cavity (i.e., the control group). Participants were asked to rate the favor request in terms of face threat, in addition to writing a response, which was then coded using message design logics. Results indicated that a request by a schizophrenic target threatened participants' positive face more significantly than that of a target with depression or without any mental illness. Participants' responses to the schizophrenic target were more likely to be conventional messages, whereas responses to the depressed target were more likely to be rhetorical messages. Theoretical and practical contributions are considered.

Biodegradability of the antioxidant diaryl-p-phenylene diamine using a modified inherent biodegradation method at an environmentally relevant concentration

The chemical product diaryl-p-phenylene diamine (DAPD), produced by The Goodyear Tire & Rubber Company as POLYSTAY 100 (CAS 68953-84-4), is employed as an antidegradant in polymers used in tires and industrial rubber products. Previous evaluations pertaining to the ecological fate of DAPD indicated a lack of biodegradative activity in aquatic media. In order to further pursue the biodegradation potential of DAPD, it was deemed necessary to enhance the sensitivity of the aquatic biodegradation assay through (a) employment of a radiotracer of the test substance, and (b) optimisation of conditions for achieving maximal solubilisation of test material in the aquatic media of the incubation vessels. Test vessels were prepared according to the OECD ready biodegradability test guidelines, with DAPD added on silica gel at concentrations of 10 or 100 μg L(-1), together with a surfactant to aid solubilisation. After 63 d incubation up to 37% mineralisation was measured and up to 29% of the applied radioactivity was incorporated into cell biomass. Also, after 28 d no DAPD could be measured in solution by radio-TLC and HPLC-MS. These three results demonstrate that the antioxidant DAPD undergoes microbiologically mediated biodegradation and is highly unlikely to persist in the environment.

Orbital aneurysmal bone cyst in a patient with renal cell carcinoma

A 43-year-old man with presumed renal cell carcinoma who was found to have an asymptomatic hot spot in his right zygoma on a bone scan during a metastatic evaluation. At the time of nephrectomy, an excisional biopsy of the lateral orbital wall was performed to rule out solitary metastasis of his renal cell carcinoma. The lateral wall was reconstructed with a rib autograft and multiple rigid fixation. Histopathologic examination of the specimen showed a fibrous matrix with large, dilated, sinusoidal, vascular channels typical of an aneurysmal bone cyst. In the absence of metastasis, the five-year survival rate is approximately 90% with nephrectomy alone.

Development of the 'Activities of Daily Vision Scale'. A measure of visual functional status

To develop a method for the evaluation of visual function in subjects with cataracts, the authors identified 20 visual activities and categorized them into five subscales (distance vision, near vision, glare disability, night driving, and daytime driving) that comprised the Activities of Daily Vision Scale (ADVS). Each subscale in the ADVS was scored between 100 (no visual difficulty) and 0 (inability to perform the activity because of visual difficulty). In 334 subjects scheduled for cataract extraction (mean age 75 +/- 9 years, 67% women), ADVS scores (mean +/- standard deviation) for each subscale ranged from 44 +/- 31 for night driving to 72 +/- 24 for near vision activities. When administered by telephone, inter-rater reliability coefficients (r) were 0.82 to 0.97 (P < 0.001) for each of the subscales, and test-retest reliability was 0.87 for the scale overall. Cronbach's coefficient alpha was very high for both the in-person (alpha = 0.94) and telephone (alpha = 0.91) formats. Criterion validity, the correlation between visual loss and ADVS score, was -0.37 (P < 0.001) when the ADVS was administered in person and -0.39 (P < 0.001) when it was administered by telephone. Content validity as assessed with factor analysis showed that 88% of the variance of the principal components weighted on one factor. The authors conclude that substantial visual disability is not captured by routine visual testing and that the ADVS is a reliable and valid measure of patient's perception of visual functional impairment.

Empowering middle managers in hospitals with team-based problem solving

A team-oriented problem-solving procedure using management project teams was developed to improve quality of care and productivity in a private, nonprofit hospital. A focus group of managers developed the procedure, endorsed by top management. The work of four manager teams that followed the procedure saved the hospital more than $500,000.

Ovariectomy of newborn rats: a descriptive surgical procedure

The ovaries of newborn rats were removed through an opening in the external abdominal oblique muscle, lateral to a dorsal midline skin incision. This approach diminished the incidence of postsurgical hernia by avoiding the exertion of intraabdominal pressure and visceral weight on a ventral midline incision. Loss of abdominal fluid, which usually occurs with ventral midline incision, also was avoided.